The following statement has been issued by the NHS Salford Clinical Commissioning Group
Between 2009 and 2012, maternity services across Greater Manchester were reorganised as a result of ‘Making it Better’, a programme of improvements to NHS services for pregnant women, babies, children and young people.
Doctor-led maternity services at Salford Royal Hospital were transferred to St Mary’s Hospital Manchester and a free-standing midwife-led unit, staffed by midwives from Saint Mary’s Hospital, opened in 2011.
What is the Salford Birth Centre?
The Salford Birth Centre, also known as the Free-standing Midwife-led Unit (FMU), is open 24 hours a day, seven days a week, and provides midwife-led care. It offers extra choice of birthplace to women of Salford in line with best practice.
It is paid for by NHS Salford Clinical Commissioning Group (CCG) and is based at Salford Royal Hospital. Women can choose to give birth at the centre if they have had a healthy pregnancy with no complications and have a good chance of a normal delivery around the time their baby is due.
If they experience any difficulties during labour or after delivery at the Salford Birth Centre, or need to be seen by a doctor, mother and baby are transferred by ambulance to Saint Mary’s Hospital. They remain at Saint Mary’s for the rest of their delivery and postnatal care.
(1) May – December 2013: Review of maternity services in Salford
There are national and local policies and strategies which guide the commissioning and provision of maternity services and which are designed to ensure women and babies receive the highest quality care possible.
Between May and December 2013, using a framework developed jointly by the National Childbirth Trust, the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, Salford CCG reviewed maternity services to look at what was working well and consistent with good practice, and what needed improving since the Making it Better reforms.
The review had a number of recommendations to improve the quality of care, such as encouraging more mothers to breastfeed and providing more support for women who develop antenatal and/or postnatal depression.
These fit with the CCG’s strategic objectives and Salford’s Joint Health and Wellbeing Strategy: to ensure all children have the best start in life and continue to develop well during their early years. In particular:
• Smoking at time of delivery in Salford is 16%. This is 4% above the current average for England (12%), and 5% above the 2015 target set by the Department of Health (11%)
• 28% of children in Salford live in poverty. In real terms this means that, in 2014, 12,720 Salford children were living in poverty
• Breast feeding initiation in 2012/13 was 58% which is 16% below the average for England (74%). By week six, 36% of all mothers are still breastfeeding, 10% below the average for England (46%).
There was also a recommendation to review the Salford Birth Centre and how many mothers were choosing to give birth there since the maternity services reforms.
(2) January – October 2014: Review of the Salford Birth Centre
When the birth centre opened, it was expected that there would be approximately 650 births per year. In early 2014, we looked at how many women were choosing to give birth at the Salford Birth Centre and found that:
• There are approximately 3,500 births in Salford per year and most women choose to give birth in hospital
• In 2012/13, 660 Salford women chose to give birth in a midwife-led birth centre
• Out of those 660 women, 221 decided to deliver at the Salford Birth Centre – this low number has been consistent since the unit opened
• A very small number (around 40) gave birth at home
Twice as many women from Salford who wanted to give birth at a midwife-led birth centre chose to go to birth centres based at the Royal Bolton Hospital, Saint Mary’s Hospital and North Manchester General Hospital, instead of the birth centre in Salford.
Considering the low uptake, a multi-agency Maternity and Early Years Project Board spent the next nine months (Feb-Oct 2014) talking and listening to service users and providers, local and national midwifery experts, our GPs, councillors and MPs to form the basis of an initial business case which evaluated three options for the birth centre.
These options were:
1. Keep the Salford Birth Centre as it is with no changes
2. Change the services so that the midwives provide full antenatal, delivery and postnatal care
3. Close the Salford Birth Centre and reinvest the funds into the early years programme and the recommendations from the maternity review
The plan was to take the business case to Salford CCG Governing Body for decision.
(3) January – October 2015: Procurement for the Salford Birth Centre
In late 2014, new national developments in maternity care came about as the business case was being finalised which were felt could influence the discussion around midwife-led services in Salford. This included the publication of the NHS’s Five Year Forward View, which announced plans for a national maternity review, and updated NICE guidelines which put greater emphasis on patient choice and mothers having all options available to them for where to give birth.
Following this, coupled with the months of talking and listening to our stakeholders about their views on what they want from maternity and early years services in Salford, the CCG’s Governing Body agreed to undertake a full procurement process to find maternity providers willing to provide the service for the birth centre based on an updated service model.
Unfortunately, following a robust evaluation from an expert panel including GPs, service users and national midwifery leaders, we were unable to appoint a suitable provider for the birth centre from the procurement.
(4) November 2015 onwards – what happens next?
Since work started on the original business case back in 2014, a lot has been happening in maternity services, both here and nationally. The NHS across Greater Manchester is going through the biggest restructure in its history through devolution, which may influence maternity services, and the results of the National Maternity Review are expected later this year.
No decision on the future of the Salford Birth Centre has been made. However, what the CCG has decided is to pause our review so we can reflect on the information we have gathered and what we have learnt whilst undertaking the procurement process. This will also give us the opportunity to look at what the recommendations will be from the National Maternity Review and how these may shape maternity services in the city.
It is important to stress that we are not making a decision in the immediate future as we want to make sure we do what is right for children and maternity services in Salford. We will continue to work with our partners, who include our service user representatives, and no decisions will be made without their contribution.
Whilst we are doing this there will be no disruption to the current service at the Salford Birth Centre, ensuring that women in Salford will still have the excellent level of choice of where to have their baby.
